Nambiar R
Department of Surgery, Singapore General Hospital.
Ann Acad Med Singap. 1987 Jul;16(3):462-5.
While the proximal or upper third of the rectum is readily accessible through the lower abdomen, lesions of the distal rectum are difficult to reach both from abdomen and the perineum. The transsacral approach (Kraske) gives excellent exposure of the mid and lower rectum. The experience using this approach in sixteen cases for various indications which include local excision of benign tumours, segmental excision, repair of recto-vesical fistula, perineal excision of rectum and abdominal excision of rectal carcinoma and low colo-rectal anastomosis with preservation of ano rectal sphincters is reported. In some cases where wider exposure of the rectum is required, this was easily achieved by excising the last three pieces of sacrum and/or extending below by dividing the external sphincter. While incontinence is not a long term problem, attention to technical details and creation of a temporary colostomy are necessary for all cases of excision and end-to-end anastomosis to prevent leakage and septic complications. Temporary colostomy is not required for excision of part of the circumference of the rectum as in the treatment of most benign lesions.
虽然直肠近端或上三分之一可通过下腹部轻松触及，但直肠远端病变从腹部和会阴都难以到达。经骶骨入路（克拉斯克氏术）能很好地显露直肠中下段。本文报告了在16例各种适应证中使用该入路的经验，这些适应证包括良性肿瘤的局部切除、节段性切除、直肠膀胱瘘修补、直肠会阴切除、直肠癌腹部切除以及保留肛门直肠括约肌的低位结肠直肠吻合术。在某些需要更广泛显露直肠的病例中，通过切除最后三块骶骨和/或通过切开外括约肌向下延伸很容易实现。虽然失禁不是长期问题，但对于所有切除和端端吻合的病例，注意技术细节并建立临时结肠造口术对于防止渗漏和感染并发症是必要的。对于大多数良性病变的治疗，如直肠部分圆周切除，不需要临时结肠造口术。
